Dr. Pickles' FM Review

Question 1

USPSTF guideline: AAA Screening

Answer 1

Men 65-75 who have smoked

Ultrasound one time

Question 2

USPSTF guideline: Diabetes Screening

Answer 2

Adults 35-70 overweight (BMI >25) or obese (BMI >30)

If positive offer or refer for multicomponent behavioral intervention for weight loss

Question 3

USPSTF guideline: Aspirin Use

Answer 3

Ages 40-59 with a 10% or greater 10 year CVD risk

Grade C

Question 4

USPSTF guideline: BRCA-Related Cancer Risk

Answer 4

Familial risk tool (women with a personal or family history of breast, ovarian, tubal or peritoneal cancer or ancestor with BRCA1/2 mutations)

If tool is positive send to genetic counseling, then genetic testing

Offer risk reducing medications (tamoxifen, raloxifene or aromatase inhibitors) to women (35 years and older) at increased risk for breast cancer and low risk for adverse medication effects

Question 5

USPSTF guideline: Breast Cancer Screening

Answer 5

Mammogram
Ages 50-74 q2 years

Question 6

USPSTF guideline: Cervical Cancer Screening

Answer 6

21-29:
Cytology (PAP) q 3 years

30-65:
HPV testing alone or HPV testing and cytology q 5 years
or cytology alone q 3 years

Question 7

USPSTF guideline: Colorectal Cancer Screening

Answer 7

Ages 45-75

FIT q1 year
FIT DNA q1-3 years
Flex sigmoidoscopy q 5 years
Flex sig q10 years with q1 year FIT tests
Colonoscopy q 10 years

Question 8

USPSTF guideline: Depression screening (adults)

Answer 8

All adults, pregnant and postpartum populations
Need system to diagnose, treat and follow up

Question 9

USPSTF guideline: Depression Screening (Kids/Teens)

Answer 9

Ages 12-18
Screen for MDD
Need system to diagnose, treat and follow up

Question 10

USPSTF guideline: Fall Prevention

Answer 10

65 yrs and older

Exercise interventions

Question 11

USPSTF guideline: Prevention of Neural Tube defects

Answer 11

Folic acid (0.4 -0.8 mg) for all reproductive age women

4mg if history of child with NTDs or on folic acid antagonists

Question 12

USPSTF guideline: Gestational Diabetes screening

Answer 12

24-28 weeks with 50 g oral glucose

Positive if >135 or > 140 mg/dL

Question 13

USPSTF guideline: Chlamydia and Gonorrhea screening in women

Answer 13

Sexually active women age 24 and younger.

Women 25 and up, screen those at increased risk

Question 14

USPSTF guideline: Hepatitis B Screening

Answer 14

Adolescents and adults at increased risk

Pregnant women at their first prenatal visit

Question 15

USPSTF guideline: Hepatitis C Screening

Answer 15

Ages 18-79

Question 16

USPSTF guideline: HIV Screening

Answer 16

All pregnant women (1st and 3rd trimesters)

Ages 15-65 or those at increased risk

Question 17

USPSTF guideline: High Blood Pressure Screening

Answer 17

Adults 18 and older

-Ambulatory Blood Pressure Monitoring is preferred

Per AAP, kids 3 and older

Question 18

USPSTF guideline: Asymptomatic Bacteriuria screening

Answer 18

Screen with urine culture for pregnant women

If positive then Keflex x 7 days , if recurrent then start suppression

Question 19

USPSTF guideline: Screening for Intimate partner violence

Answer 19

Screen in women of reproductive age

If positive refer to support services

Question 20

USPSTF guideline: Latent TB Screening

Answer 20

Screen for LTBI in at risk patients

Risks: Born or resided in countries with increased TB prevalence, lived in high risk setting like homeless shelters or jail, immunosuppressed

Question 21

USPSTF guideline: Preeclampsia prevention

Answer 21

Screen with blood pressure at each visit

Aspirin (81 mg daily), starting after 12 weeks gestation in women at high risk for preeclampsia

Question 22

USPSTF guideline for Lung Cancer Screening

Answer 22

Low dose CT scan yearly

50-80 with 20 pack year hx and currently smoke or quit within the past 15 years.

Question 23

USPSTF guideline: Obesity screening in kids and teens

Answer 23

Kids 6 years and older

BMI 85-95%ile overweight, above 95%ile obese (BMI percentile age and gender)

Offer/refer to intensive behavioral interventions to improve weight status

Question 24

USPSTF guideline: Ocular prophylaxis for Gonococcal Ophthalmia Neonatorum

Answer 24

Use prophylactic ocular topical medication for all newborns

Question 25

USPSTF guideline: Osteoporosis Screening

Answer 25

Women >65 years Women <65 if increased risk (FRAX score)

Question 26

USPSTF guideline for Prevention of HIV

Answer 26

Offer preexposure prophylaxis to persons at high risk

Question 27

USPSTF guideline: Rh(D) Incompatibility Screening

Answer 27

Rh screen at first visit For Rh-neg women, repeat screen at 24-28 weeks -if negative give immunoglobulin then again within 72 hour after delivery if Rh-positive newborn

Question 28

USPSTF guideline: Skin Cancer Prevention

Answer 28

Counsel fair skinned people, 6 months to 24 years to minimize UV exposure

Question 29

USPSTF guideline: Statin Use for the Primary Prevention of CVD in adults

Answer 29

1) ages 40-75 2) 1 or more CVD risk factors (dyslipidemia, HTN, DM, smoking) 3) 10 year ASCVD risk 10% or greater

Question 30

USPSTF guideline for Syphilis Screening

Answer 30

Screen all pregnant women and anyone at increased risk Grade B

Question 31

USPSTF guideline: Vision Screening

Answer 31

At least once in all kids ages 3-5 years old

Question 32

Obesity medication and bariatric surgery criteria

Answer 32

Meds BMI >27 with comorbidity BMI > 30 Also Offer/refer intensive, multicomponet behavioral interventions Bariatric surgery BMI >30 with comorbidity BMI >40

Question 33

USPSTF guideline: Thyroid Screening

Answer 33

Do not screen nonpregnant, asymptomatic adults

Question 34

USPSTF guideline: Prostate Cancer Screening

Answer 34

Men 55 to 69 years: shared decision making Men 70+ do not screen

Question 35

What are the high and moderate risk factors for Preeclampsia?

Answer 35

Risks: High: hx of pre-e, multifetal gestation, chronic HTN, T1 or T2 DM, Renal disease, Autoimmune (SLE, antiphospholipid) Moderate: nulliparity, obesity, family hx of pre-e, >35 years, AA, low SES, SGA, low birth weight, >10 years between pregnancies, previous adverse outcomes

Question 36

USPSTF guideline for screening for anxiety in children and adolescents

Answer 36

Screen for anxiety in ages 8-18 Grade B